Health and inequity in Australia
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2023)

In this issue of The Lancet Public Health, Shariful Islam and colleagues examine the state and trends of disease burden in Australia from 1990 to 2019. In brief, life expectancy has increased by 6 years and a major success has been the drastic decline in age standardised mortality rates in the top three causes of mortality, ischemic heart disease, stroke, and tracheal bronchus and lung cancer. However, to take stock of the health of Australians the question is not only what is the burden of disease but also who carries the burden of disease? Non-communicable diseases remain the main drivers of disease burden in Australia. Based on Islam and colleagues’ analyses, their leading risk factor is high body mass index, which has overtaken smoking in 2019. This is likely due to Australia's strict tobacco control measures, which have coincided with a steady decline in smoking prevalence down to 11%. But prevalence of daily smokers remains high in those with socioeconomic disadvantage and are more than three times the national average for Aboriginal and Torres Strait Islander people. Obesity prevalence is increasing and in unequal rates. 31% Australians live with obesity, 38% for those who did not complete secondary education; the proportion reaches 43% for First Nations peoples. Notably, the distribution of risk factors between First Nations and Non-Indigenous Australians overlaps with socioeconomic determinants such as education or employment, which are also unequally distributed. In this issue, Kim Kiely and colleagues strengthen the evidence on inequalities by education in their longitudinal study on healthy working life expectancy in the Household Income and Labour Dynamics in Australia survey. Although total and working life expectancy at 50 years increased, those who did not complete secondary schooling mainly gained years working in poor health and lost overall healthy life expectancy. The burden of risk factors and distribution of social determinants in Aboriginal and Torres Strait Islander peoples is the result of historic policies and discrimination. These disadvantages feed a cycle of ongoing discrimination creating further barriers to better outcomes for physical and mental health. The latest Closing the Gap report by the Productivity Commission of the Australian Government, which monitors progress in reducing inequalities in the Australian First Nations, paints a sobering picture. Although some improvements have been observed, the increased proportion of Aboriginal and Torres Strait Islander peoples completing high school (68%) has been too modest to reach the national target (96%). There has also been a worsening in some outcomes, for instance adult suicide, which is already twice as common in this population, showed an upward trajectory. A sign of hope is the observed reduction in the rate of First Nations young people in detention, which is on track with the target for 2031 (30%). The impact of incarceration on young people‘s health is documented by Lucas Calais-Ferreira and colleagues also in this issue. Compared with peers in the general Australian population, the authors find a 4-times higher risk of early mortality and 1·7 times higher risk of death from non-communicable diseases in young people with a history of incarceration. Overall, the analysis of the Global Burden of Disease Study 2019 by Islam and colleagues shows increases in life expectancy and reductions in disease burden in Australia. But the burden is disproportionally carried by people with socioeconomic disadvantage and the First Nations peoples—with an 8·6 years shorter life expectancy in men and 7·8 years in women compared with Non-Indigenous people. Health inequities stem from social, cultural, environmental, and historical determinants. Targeted public health approaches and action are needed to address health inequalities. But historically Indigenous populations have been excluded from decision making on matters affecting their health and wellbeing. Later this year, Australia has the opportunity to establish a constitutionally enshrined Voice of Aboriginal and Torres Strait Islander peoples, an independent and permanent advisory body that will have the ability to speak out and advise the Australian Parliament and Government on matters that affect the lives of First Nations peoples. We welcome the Public Health Association Australia, the Australian Academy of Health and Medical Sciences, and the Australian Medical Association supporting the constitutional amendment for Aboriginal and Torres Strait Islander peoples to be heard to tackle health inequalities. For data on obesity and overweight see https://www.aihw.gov.au/reports/overweight-obesity/inequalities-overweight-social-determinants-health/summary For data on obesity and overweight see https://www.aihw.gov.au/reports/overweight-obesity/inequalities-overweight-social-determinants-health/summary Gender, education, and cohort differences in healthy working life expectancy at age 50 years in Australia: a longitudinal analysisIncreases in length of working life have not been accompanied by similar gains in healthy life expectancy for women or people of any gender with low education, and it is not unusual for workers older than 50 years to work with long-term health limitations. Strategies to achieve longer working lives should address life-course inequalities in health and encourage businesses and organisations to recruit, train, and retain mature-age workers. Full-Text PDF Open AccessThe burden and trend of diseases and their risk factors in Australia, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. Full-Text PDF Open AccessNon-communicable disease mortality in young people with a history of contact with the youth justice system in Queensland, Australia: a retrospective, population-based cohort studyYoung people with a history of contact with the justice system are at increased risk of death from NCDs compared with age-matched and sex-matched peers in the general Australian population. Reducing youth incarceration and providing young people's rights to access clinical, preventive, and restorative services should be a priority. Full-Text PDF Open Access